Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A88078 | CA |
Y | 2080P0202X | Pediatric Cardiologist | A88078 | CA |
NPI | 1144378852 |
---|---|
Provider Name | Jeffrey Robert Frazer |
First Address | San Diego, CA 92123-4800 |
Second Address | San Diego, CA 92123-2746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 24/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A880780 | (05) | CA |